It is estimated that 4.5 million Poles suffer from kidney disease, although most do not guess it, because even 90% damaged kidneys may not send any alarm signals. So how do you recognize that they are functioning worse and worse? Some problems as well as anatomical changes and related (even unusual) symptoms can be expected by looking at PESEL.

Contents:

  1. How your kidneys age - kidney function
  2. How the kidneys age - degenerative changes in the kidneys
  3. How your kidneys age - risk factors
  4. How your kidneys age - important self-observation
  5. How your kidneys age - prevent disease
  6. How your kidneys age - Kidney disease

Although the kidneys work intensively around the clock and are responsible for many important processes in the body, they do not let you know about their problems for a long time. Therefore, as you get older, your kidneys need to be checked regularly. This is the only way to detect changes that are already irreversible at an advanced stage.

Urinary tract diseases affect both adults and children. Per 1,000 births, 3 to 6 children are born with kidney defects. However, even in he althy people, these small filter organs gradually wear out. Research shows that after the age of 40 The effectiveness of kidney function decreases by about 10% with each subsequent decade, thus increasing the probability of developing chronic kidney disease (CKD). The vast majority of Poles equate this disease with frequent visits to the toilet. Meanwhile, difficulties in urinating are not a specific symptom of CKD.

How your kidneys age - kidney function

The kidneys are bean-shaped organs located in the abdominal cavity, in the retroperitoneal space. Due to the close proximity of the liver, the right kidney is approx. 2 cm lower than the left kidney. Multitasking, so fashionable these days, is the hallmark of our kidneys, which work on several jobs.

During the day, 1500 liters of blood flow through them (therefore they have a maroon color), as a result of filtration, about 200 liters of primary urine are produced. This is about as much as we could fit in a large bathtub. It should be emphasized here that each of the kidneys weighs only 120,200 g (dimensions 10x5x3 cm).

The entire filtration process is called glomerular filtration (GFR), which produces 1.5-2 liters of urine. FROMPrimary urine is formed in the kidney glomerulus of blood filtration, then reabsorption takes place in the renal tubules, which allows the body to recover substances valuable for the body, e.g. vitamins, minerals and some water.

The final urine contains mainly: water, urea, the end product of the metabolism of proteins and other nitrogen compounds, harmful metabolic products, toxins and drug metabolites. Therefore, the kidneys remove harmful metabolic products from the body, maintain an adequate fluid balance - they dilute or thicken the urine as needed - and maintain the balance of minerals (sodium, calcium, potassium and phosphates).

They also have an effect on blood pressure. The kidneys also produce the active form of vitamin D (calcitriol) for strong bones and better immunity, and erythropoietin (EPO), which enables the production of red blood cells in the bone marrow.

How the kidneys age - degenerative changes in the kidneys

As prof. John Bertram of Monash University, the structure and he alth of the kidneys have to do with what happened in the womb. The nephrons that make up the kidneys are formed by the 36th week of pregnancy. Man is born with about 1 million nephrons in one kidney, and each year he loses about 6,000 nephrons. However, these numbers can vary considerably: in some people it may be as low as 200,000. nephrons, while in others it is 2 million.

Importantly, their number depends on the birth weight: if it is low, there will be fewer nephrons. That is why specialists increasingly emphasize the importance of the he alth of a pregnant woman. A diet rich in fat, drinking alcohol, overusing antibiotics, and high levels of stress negatively affect the development of the kidneys in a child.

The consequences of low birth weight may appear even 40 years after birth. What anatomical and structural changes occur in each person's kidneys over time?

  • Weight reduction

The number of the glomeruli is decreasing every year. Renal tubular atrophy and interstitial tissue fibrosis are observed. Therefore, this organ shrinks over time. Weight loss occurs mainly in the cortex (the outer part of the kidney) and, to a much lesser extent, in the renal medulla. Therefore, in people over 75 years of age kidneys can be up to 15-20% smaller than in 25-year-olds.

  • Deterioration of filtration

Around the age of 30 with each subsequent year, the glomerular filtration capacity deteriorates, i.e. the first stage of urine formation, as a result of which the so-called primary urine, yieldingthen concentration to final urine.

In a 70-year-old person, the number of active glomeruli decreases as a result of their hardening. The lobular structure of the glomeruli is partially obliterated, the number of epithelial cells increases, which also reduces the size of the filtration surface of the kidneys.

  • Weaker blood supply

As a result of the aging of the organism, the blood supply to the kidneys deteriorates, which translates into their worse functioning. In people between 50 and 80 years of age blood flow through the kidneys is reduced by almost half, from nearly 1 l / min to approx. 500 ml / min.

The main factor contributing to this is the reduction in the renal vascular bed. The blood flow through the renal cortex is mainly lowered, while the flow through the spinal part is maintained.

In people over 70 years of age with normal blood pressure, the frequency of changes similar to those that occur in young people with arterial hypertension increases. It is about narrowing the interlobular arteries and increasing the tortuosity of the intralobular arteries.

With all these changes, there is talk of an age-related nephropathy. Most often, nephropathy, i.e. kidney damage, is a consequence of hypertension or hyperglycaemia, i.e. increased blood glucose levels in people with diabetes. In this case, it is related to the aging of the body's cells.

Factors that increase the risk of developing age-related nephropathy include: male gender, genetic background, hypertension, hyperlipidemia, obesity, high protein diet, smoking. In the elderly, there are also reports of tubulo-parenchymal changes caused by drugs or recurrent urinary tract infections.

  • Less ability to homeostasis

A consequence of aging-related changes in the renal tubules is that the ability of the kidneys to thicken, dilute and acidify urine is decreased, and the ability to alter the amount of sodium excreted in the urine decreases.

Therefore, limiting fluid intake (especially in a person over 60) significantly increases the risk of dehydration. It is believed that the ability to concentrate urine decreases by about 5% over a decade.

How your kidneys age - risk factors

When the kidneys become less able to fulfill their functions, we are called kidney failure. There are two forms: acute and chronic.

Acute kidney failure means sudden impairment of kidney function, and its causes include:

  • decreased blood flow through the kidneys,
  • damage to their flesh,
  • obstructionurine.

The most common causes of this type of trouble are sudden blood loss (hemorrhage), heart failure or dehydration caused by e.g. diarrhea or vomiting.

We talk about chronic kidney disease when kidney damage lasts longer than 3 months. This condition can be caused by diseases such as:

  • diabetes,
  • atherosclerosis,
  • hypertension,
  • glomerulonephritis,
  • renal cystic disease,
  • birth defects.

When the kidneys stop working or show only trace functions, we talk about their end-stage failure, which requires renal replacement therapy: dialysis or kidney transplantation.

It is assumed that every year in Poland 130 people out of a million completely lose their kidney function and require renal replacement therapy, and about 3,000 people per million develop progressive CKD every year.

The risk of developing the disease increases with age, and this disease affects up to 30% of people over 65 years of age. The main risk factors for CKD are: diabetes, arteriosclerosis, obesity (BMI>30), hypertension, cardiovascular disease, smoking, age over 50 and family history of kidney disease.

How your kidneys age - important self-observation

It is worth doing a urine test once a year (with determination of serum creatinine concentration with calculation of estimated GFR). The urine of a he althy person should be clear, straw-yellow in color, with a slight ammonia odor. The first one, given in the morning, may be a bit darker.

You have to remember that sometimes it changes color due to what you eat or it smells bad after eating asparagus and some penicillin antibiotics. The presence of protein in the urine may be indicated by foaming of the urine (any presence of proteinuria is an indication for medical consultation).

It is disturbing when for no apparent reason: the smell becomes definitely unpleasant, the color - strange (e.g. red, which may indicate the presence of blood), the amount is too small (less than 400-500 ml per day for an adult persons) or too large (more than 3 liters a day), and when we go to the toilet more often than usual or very rarely.

Pain in the lumbar region, especially stabbing and intensifying with breathing, may indicate acute inflammation of the kidneys or kidney stones. An ultrasound is a simple examination to assess the size and structure of the kidneys.

How your kidneys age - prevent disease

In order for the kidneys to work efficiently, you need to drink 2-3 liters of water a day, i.e. 8-12 glasses. On average, 20-30% of this requirement is covered by meals. The content also mattersdietary potassium - minimum 3.5 g / day. It is worth controlling blood pressure and following a he althy diet (preferably the DASH diet) that will help you maintain a he althy body weight.

It is also recommended to quit smoking (toxins damage nephrons), significantly reduce the consumption of common table s alt, animal protein and alcohol. Specialists suggest regular physical activity (at least 30-40 minutes 2-3 times a week).

You have to pay attention to medications. Often taken by seniors, e.g. for painkillers and anti-inflammatory drugs, some cardiovascular drugs, antibiotics, and drugs for insomnia have some potential to damage the kidneys (they may be nephrotoxic).

Kidney diseases are often a consequence of poorly treated angina or colds or frequent infections of the genitourinary system

How your kidneys age - Kidney disease

  • Diabetic Nephropathy

A filtration disorder manifested by an increase in the amount of protein excreted in the urine. This is a consequence of the fact that the tiny blood vessels in the nephrons have been damaged as a result of prolonged excess sugar in the blood (hyperglycemia).

In type 1 diabetes, diabetic nephropathy occurs most often in people who are poorly treated, have diabetes for many years, have too high blood and urine glucose levels for a long time, and elevated glycosylated hemoglobin values. In people with type 2 diabetes, nephropathy is often diagnosed along with the diagnosis of diabetes.

The high real risk of this complication is evidenced by the fact that the disease develops in nearly 40% of patients with type 1 diabetes (requiring insulin injections) and in 5-40% of patients with type 2 diabetes.

  • Urolithiasis

Usually attacks men between the ages of 30 and 50. As a result of the disease, deposits crystallize in the kidneys - the so-called kidney stones. At first they resemble sand, then stones. The disease is usually asymptomatic until a plaque obstructs the ureter, causing a pain called renal colic. Urolithiasis requires pharmacological treatment (in 70% of patients), in some cases it is necessary to remove the stones (e.g. extracorporeal - with a shock wave).

  • Uretero-bladder drainage (OMP)

This is a condition in which urine flows back out of the bladder and can travel through the ureters back to the kidneys, causing them to become inflamed and scarred. It is the result of both a birth defect and inflammation of the bladder

  • Kidney cancer

More often it concerns men, usually those over 60 years of age. Since it is asymptomatic initially, the disease is detected in the advanced stagestage. Pain in the lumbar region and blood in the urine, frequent urge to urinate, recurrent urinary tract infections and swelling in the legs may be disturbing warning signs.

The appearance of protein in the urine is not always associated with kidney damage. Sometimes its presence (but in small amounts, proteinuria above 3 g per day is always a pathology) is the result of: intense exercise (on the last day), urinary tract infection, increased body temperature, stay in a sauna or high blood pressure. There are also errors when taking a sample for testing. To confirm CKD, the test deviation must have been present for a minimum of 3 months.

The kidney is the organ that is most often transplanted. As much as three times more often than the heart and almost 8 times more often than the liver.

About the authorJoanna Karwat A journalist specializing in he alth matters. For over 25 years, she has been following trends in medicine and meets doctors to talk about new treatments. She received two distinctions in the "Medical Journalist of the Year 2022" competition in the press journalism category. He spends every free moment playing volleyball. She won gold in the Beach Volleyball Journalists Championship in 2016.

Category:

Geriatrics